Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

Yes To No Tobacco Until Age 21

Teen smokingHear me straight: we don’t want anyone addicted to tobacco products. No question it’s an ugly habit and a terribly complex addiction. Expensive, detrimental to health, so very ugly… So I’m all for WA State House Bill 2313 (SB 6157) supporting moving the purchase age of tobacco from 18 to 21. Yes I know you can vote and enlist in the military at 18, but inconvenient or not, teen brains are not fully developed by the time they enter college-age and the effects of nicotine and the trend towards lifelong addiction are seriously grim. Complain all you want that Washington would be a “nanny state” but the facts are clear: if you start smoking at a young age, odds are that you will still be smoking as an adult. We know that more than 80% of all adult smokers begin smoking before the age of 18; and more than 90% do so before leaving their teens. We need to get tobacco out of reach so we can stop addiction before it starts. This isn’t just about public health it’s also about the health care spending of your tax dollars.

My friend and colleague Dr. John Wiesman (WA Secretary of Health), gave a press conference this week on the new bill. Here are a few staggering excerpts from his speech:

Counting cigarettes, smokeless tobacco, and e-cigarettes together, in 2012, 12 out of every 100 10th graders used these products, and by 2014 that number had risen to 20 out of every 100. That’s a frightening 67%  jump in just 2 years!

Both cigarettes and e-cigarettes set kids up for a lifetime of addiction and poor health.

The most effective way to stop this trend is to stop our kids from smoking before they start.

Middle school, high school and college students are still undergoing significant brain development.

Nicotine exposure during this critical time appears to affect the structure and function of the brain and may lead to lasting cognitive and behavioral impairments.

If that’s not enough reasons to support this work, I don’t know what is. But, here’s one last piece of data that will hit you square in the wallet (ouch). Each year in Washington alone, we spend: Read full post »

10 Reminders And Updates to Pediatric Check-Ups

Pediatric Wellness Visit

Prevention is genius medicine. By making smarter choices, detecting risk early, not only do we improve our quality of life, but we can prolong people’s lives. Pediatrics is the perfect place to master this. Because of the incredible opportunity we have to prevent injury and illness during a person’s childhood, the American Academy of Pediatrics (AAP) updates and refreshes their schedule of recommended screenings and guidelines for wellness visits every year. It’s put into a huge “periodicity table,” basically a chart that reminds us all what to do when. This year some of the recommendations are making headlines. I’ll explain reminders about what you should expect from wellness visits, include all the new updates, and explain a bit more about a couple of the new recommendations (HIV screening for all teens 16-18) in these 10 tips:

  1. Vision: annual, regular vision screening is important. Pediatricians evaluate vision from day one but your child should stand in the hall and screen vision formally at age 4 years (at 3 is great if they can follow directions!) and yearly until  age 6, and then every two years. At age 18, the vision screen will only be given to those at risk or who flag concerns.
  2. Oral Health: an oral exam from physician or dentist is a must at the time of baby’s first tooth eruption. This year, the AAP also endorses that pediatricians provide annual fluoride varnish to children between 6 months – 5 years to reduce cavities.
  3. Drugs & Alcohol: CRAFFT (Car, Relax, Forget, Friends, Trouble) tool will be used to screen adolescents for drug & alcohol use. This screening tool is used to help teens share ways they use alcohol or drugs and identify any risks. Writing it down can help teens share information that may be hard to talk about and the recommendation to formalize this and build this into our electronic health records so it is captured each and every time is smart.
  4. Depression: all children ages 11-21 will be screened for depression. Screening can be done through a combination of filling out survey questions and also questions we ask teens and their families directly. Suicide is a leading cause of death among adolescents — picking up depression or sadness, intervening with counseling, social support, and sometimes medication is essential for supporting teens without proper treatment or support.
  5. Cholesterol: the AAP recommends a blood test will be given to patients between age 9 and 11 universally to screen for elevated blood cholesterol and other blood fats. Because 1/5 children between 12 and 19 have one or more abnormal lipid level, screening is a way to pick up those we don’t suspect. The reason for recommendation is this: atherosclerosis (cholesterol sticking to the insides of your arteries) begins in childhood and accumulates throughout our lives. The more atherosclerosis, the more your risk of a heart attack or stroke. Because heart disease is the #1 killer of both men and women, PREVENTING the accumulation in childhood can potentially lower lifelong risk. If children have a family history of high cholesterol, early heart disease or death in the family (under age 55 years) are obese or have other underlying health conditions like diabetes, children will be screened even earlier (between age 2 to 5). With no risk factors, all children should be screened once between age 9 to 11. The original policy and statement with this recommendation came out in 2011 and I’ve picked up children with elevated cholesterol since. I’m thankful for this recommendation!
  6. Development & Autism: developmental screenings will happen at all ages and all wellness visits. Formal autism screenings will occur at 18 months and the 2-year check up. No changes to this schedule this year.
  7. HIV: every teen age 16-18 should be screened for HIV regardless of sexual activity. In years before 16, and after 18, this is based on risk, social history, exposures. But the reason for screening teens universally is help children know their HIV status, keep them negative, and ensure we’re picking up HIV early when it’s unexpected for early treatment. The facts behind this recommendation:
    1. 1 in 4 new HIV infections occurs in youth ages 13 to 24
    2. 60% of all youth with HIV do not know they are infected
  8. Pap smear & HPV: doctors and nurses will do internal gynecologic exams if any concerns (pain, unusual discharge, menstrual cycles concerns, sexually transmitted disease exposure or diagnosis) but will wait to do a pap smear and HPV testing as screening to look for the presence of pre-cancerous cells on the surface of the cervix, at age 21. Here’s a video where I explain recommendations for “well-women and well-girl” gynecologic exams.
  9. Newborns: AAP recommends all babies get screened for heart disease by auscultation of the heart using a stethoscope and ALSO by using pulse oximetry before leaving hospital or in the first 3-5 days of life.
  10. Growth & Nutrition: your child’s doctor should show you and teach you at EVERY VISIT how your child is growing. They should review their height and weight gain as well as their BMI (or weight/length at young ages) at every visit. Growth is a great marker of thriving health and concerns around growth can really help change a child’s live.
    1. 1/2 of parents underestimate their children’s weight so it’s important to review the numbers every year as they sometimes surprise. 1/3 of children in US are overweight or obese and knowing this early can provoke big changes.
    2. AAP recommends toddlers be checked at 15 and 30 months for iron deficiency — iron is not only important for building strong blood it’s essential to support proper development.
    3. Supplemental Vitamin D also very important for infants and children — 400 IU typically recommended for all infants and children, every day. Ask your pediatrician or family doc for more information.

Read full post »

No Kitchen Spoons! Correct Medication Dosing

OTC Dosing Image

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools sometimes making it confusing for parents to ensure we are giving our children the proper dose. To add to the confusion, sometimes the recommended dose is written with different units (mLs, mg, or teaspoons) than the dosing device. For example, the box might have dosing in “teaspoons” and the measuring device be divided up into milliliters. This issue is not new but guidelines and protections around the problem are increasing. A win!

This has concerned me for a long time. To drive this point home even further, I gave a dosing conversion quiz on my blog to my colleagues in medicine (also parents) who even struggled to get the dosing correct. The dosing struggle is REAL to non-pediatric docs and parents everywhere.

For example, you may even see differences in devices that would seem to be standard across medications. The dropper that comes with liquid acetaminophen may look very different than the dropper that comes with liquid vitamin D or infant multivitamins. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication. Read full post »

Quick Ask This Flu Season: Peer To Peer Protection

If our entire community got the flu vaccine we’d be MUCH less likely to share it. We’d also be much less likely to get influenza. Studies find that about 10-40% of children get influenza each season. Because their immune systems are a bit “naive” to influenza, they are at risk for more serious illness, especially if under age 5 years.

What if parents were the ones to endorse protection from influenza? What if we drove our schools and playgroups and community protection? I want our communities safe and healthy this flu season and our best defense is the flu vaccine, staying home when ill, and covering our coughs. It may be the mom-to-mom-dad-to-dad message that is most powerful…

The match between the flu vaccine (nasal spray and the shot) and circulating strains of influenza are better this year (including the H3N2 strain). That means the flu vaccine will likely be far more effective in protecting our families!

Data has shown us that nearly 1/2 of the adult population does NOT get their flu shot, yet 75% of parents to young children DO get their young children and toddlers vaccinated. Parents really do want their children protected and although pregnant moms are at high risk for flu only about 50% got their flu vaccine last year. Not only does mom get protection of her own health when she gets the vaccine, she passes on antibodies to her baby!

Will you share a video with your community? I created the below series of flu videos in partnership with The American Academy of Pediatrics targeted to specific demographics and age ranges. You can share them via email, social media or in-person. Help me make the case to ensure our kids are healthy and protected this flu season. I’ve provided the videos and links to share them below. Thank you for joining me in avoiding influenza this year. Share one of these videos?

8 & Under: Why Flu Vaccine Is an Every-Year Thing!

Link to share: https://www.youtube.com/watch?v=kS9mgx8Bemg

 

Read full post »

Flu Season, Pregnant Moms, And The GOP Debate

NFID T.F.

A selfie with Dr. Tom Frieden, Director of Centers for Disease Control (CDC)

It’s been a whirlwind this past week. Last week I flew to Washington D.C. as an invited speaker at the NFID Influenza News Conference at the National Press Club in Washington D.C. I joined thoughtful experts: Drs. Tom Frieden, Kathy Neuzil and Bill Schaffner to present the 2015/16 flu season recommendations and explain rationale for every-year flu vaccine. It’s an essential vaccine for children, especially as young children are at elevated risk for more serious or even deadly influenza infections. Timing auspiciously peaked interest in the news as the press conference was in the morning immediately after the presidential candidate debate where wild myths were shared on stage about vaccine science and safety. I was able to also share my refute of Trump’s false statements here on NBC Nightly News.

I got my flu vaccine at the event in front of the cameras. Thanks to the new jet-injected vaccines (truly a needleless “shot”) it didn’t even hurt! As expected, I was sore in my arm for a day or two thereafter.

Prepping for the press conference, I was a little underwhelmed to learn that only roughly 50% of pregnant women get the flu vaccine. If you’re expecting, here’s what you need to know about the flu vaccine. Quick 1-minute video below. SPOILER: it’s an essential and safe vaccine to get at any point of your pregnancy. Read full post »

How To Read OTC Medication Labels

reading labels 1Reading and familiarizing yourself with the drug facts label is perhaps more important than it seems before you administer an over-the-counter (OTC) medicine to your children. I think we may get more hands-off at times than is ideal. And I think caregivers who casually help us with our children (grandparents, babysitters, nannies, neighbors) can too. Although it’s inconvenient to fill out forms for medicine administration in daycare, preschool and school, these locations seem to be the environments with the most safety around OTC medicine delivery. Those forms help remind us how important this stuff can be.

With little ones and children all heading back to school, as parents we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the inevitable fall, wintery illnesses resume, it’s a great time to set aside some time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, etc. In some ways it’s combination medicines that make me worry the most.  Read full post »

4 Things To Know If Your Son Is Off To College

male college prepYou may have already read yesterday’s blog on preparing your daughter for college. Much of my advice for girls, of course, also pertains to boys (and vice versa). I’m writing two separate posts only for the purpose of getting people to read this content, not to differentiate. I added one section here for boys (on alcohol and risks) not because it’s an issue for boys only. In fact, we know that 1 out of every 5 high school girls binge drinks (see below).

If you have a boy heading off to college this fall there are a few things to know to help improve his safety and success this year. Of anything I know from my experience being a previous school teacher, and now pediatrician and mom to boys (still 10 years away from college!) the transition from HS to college-age is one steeped in emotion for all. In addition to the tips I’ve provided for girls, alcohol and the HPV vaccine are topics to discuss to ensure it’s a better and safer year for your son (or daughter) this year.

ONE: Safe Sex & Birth Control – What Your Teen Son May Need To Know:

Read full post »

Core Memories: Staggeringly Powerful

Sadness, Fear, Anger, Disgust, and Joy ... from Pixar's "Inside Out"

Sadness, Fear, Anger, Disgust, and Joy … from Pixar’s “Inside Out”

Over the weekend we saw the movie, Inside Out, with our boys. After reading previews of the film, I expected to be moved and somewhat thrilled by the look at mental health and emotions. But I walked away with a somewhat unexpected emotion: motivation.

Motivation for presence and for patience with my little boys. To me, the movie felt like a whisper, a gentle reminder in my ears to the power of each and every early experience our children take in. A prompt into the profound opportunity good — or even challenging — moments have to shape the foundation of a little developing human. Yes, we know this instinctively, but sometimes it takes a cartoon to jolt us back into focus. I’m motivated to remember that we can’t always carry the heavy load that EVERYTHING we do with our children matters all the time but it is nice to know some of these experiences really will stick forever. Read full post »

Working With Babies Of Any Age

Illustration about what it feels like to go back to work by David Rosenman

Leaving anyone we love is fraught with duplicity. While we feel the tug of distance, we have the fortuitous lens to see two things at once: the treasure of the bond forged and the aching feeling of distance when it’s gone. This binocular into our lives inspires joy but it also occasionally does bear weight. I’ve often said that leaving my babies (now children, but let’s be honest they’re always my babies) and going to work feels a little like walking around without a limb or without a necessary body part. Without them around something essential is glaringly absent. At times thinking on them is wildly distracting, especially right at first.

Up there, look at that graph. Haven’t you had days like this?

The fortune in raising and loving children is that we’re continually reminded of these dual realities. Life after a baby is forever transformed; as parents we are never again simply singular. Or at least as I see it, we’re not entirely whole again when alone. When we meet our babies big real estate in the heart is rapidly taken up by our children and although wandering, working, traveling away, and seeking new experiences is essential to our personal evolution, we do always seem to notice the absence of our babies when we’re apart. I’m coming to know this is true at any age. Read full post »

Power Of A Google Search: Community

5-22 Addison

2-year-old Addison Hyatt survived a  pediatric stroke at birth. (Image courtesy: Kaysee Hyatt)

One Google search can sometimes change everything.

After learning something new about our child’s health or condition, especially for worried parents and caregivers, leveraging online search as a resource in diagnosis, clarification and education is typical behavior. Searching out support, camaraderie and tips online just makes sense. In fact, 2013 data from the Pew Research Center finds that 1 in 3 Americans goes online to search for information and support in finding a diagnosis. If you’re a woman, college-educated, or younger (under age 49) the likelihood of searching online increases and approaches 50%. Not only are we searching for health info and connection online, we’re doing it more so with mobile devices. Pew data from April 2015 finds that 64% of Americans have a smartphone and that 6 in 10 are searching for health info on a mobile device.

That smartphone in your pocket can connect you to information yes, but also to others like you. Read full post »